OAR 413-050-0430: Other Medical Payments

"Other Medical" payments are not federally matchable and are paid out of General Fund dollars. "Other Medical" is to be used for required medical services for a child in ODHS care and custody by court order or voluntary placement or custody agreement either in or out of substitute care, or parents or other adults identified in the child's case record. "Other Medical" is only to be used if the service is not available through Mental Health or DMAP as a Medicaid covered service. Payments from "Other Medical" may be made in the following situations: (1) Drug and alcohol assessments for persons not eligible for Title XIX or the Oregon Health Plan. (2) A one-time emergency medical need for children in the custody of the Department that have been returned home. This is limited to children of low-income families not eligible for medical services through the Department. (3) Therapy for Children in Substitute Care, if recommended by a licensed psychiatrist or psychologist who evaluated the child, and the type of therapy and/or the therapist recommended is unavailable from the local mental health clinic or through the CCO in which the child is enrolled. The therapist must be enrolled with DMAP or, failing that, there must be a signed contract in place prior to the therapy being provided. Funding availability will be determined by the District Manager or Designee (who may want to consult with the Medical Assistance Resource Coordinator to determine that there are no other resources available for funding). (4) Medical care for children in detention. ORS 418.034 mandates payment of the cost of medical care for the child in detention, including emergency medical care, if the child is in custody of the ODHS. "Medical care" means emergency medical care or medical care for a medical condition that existed prior to the child's being held in a juvenile detention facility or in a local correctional facility or lockup. (5) Evaluations of parents when required by the Department for casework planning to determine the parents' emotional stability, intellectual capacity, parenting capacity or maturity. These may include medical, psychiatric, psychological evaluations or drug and alcohol assessments. This does not include ongoing treatment or services. Payment from "Other Medical" for the above services will not be made for parents in permanent planning cases or for parents who are Medicaid eligible through the Oregon Health Plan (OHP). Evaluations will be reimbursed at the current established DMAP rates. (6) Parent/child and/or sibling interaction evaluations reimbursed at the current established rates.